Entry › For parents · Last reviewed 2026-05-16

For parents

What you should know before a gender clinic admits your child to a pathway with irreversible consequences.

Read this first

The Dutch Protocol — developed in the Netherlands, applied worldwide — has since 2020 been critically reassessed in virtually every country outside the Netherlands. British, Swedish, Finnish, Norwegian and Danish evaluators classified the evidence as "very low certainty". NHS England withdrew the routine supply of puberty blockers in 2024. The Netherlands continues the protocol without its own independent evidence review. Parents who consider entrusting their child to this pathway have a right to that information — not as opinion, but as fact.

What the protocol entails

Puberty blockers (GnRHa) from ~12 years old. Presented as a "reversible pause button" — a formulation that the Cass Review and Levine et al. (2022) identify as misleading. 96–98% of those who start continue to cross-sex hormones. See the three phases.
Cross-sex hormones from ~16 years old. Effects on fertility, sexual function and bone and cardiovascular health are partly irreversible, partly unknown.
Surgery from 18 years old. Fully irreversible. WPATH SOC-8 removed age limits after publication.

Questions to ask before you consent

Which independent (non-AUMC) systematic review underpins the treatment of my child?
Has comorbidity (autism, depression, trauma, eating disorder) been systematically investigated? In the original VUmc cohort 7.8% had an ASD diagnosis; internationally it rises to 35%. See exclusion criteria.
What specific information will my child receive about loss of fertility, sexual function and the irreversible character of CSH and surgery? See informed consent.
What is the clinician's position on the Cass Review, SBU and COHERE? Are these reports discussed — or waved away?
Which psychosocial interventions (talk or family therapy, autism assessment, trauma treatment) have been offered before hormones are considered? That is the first recommendation of both COHERE and Cass.
How long and with which outcome measures will my child be followed after treatment starts? The original Dutch studies stopped one year post-operatively. See follow-up.

What to be prepared for

The "transition or suicide" framing, according to the WPATH Files, has no empirical basis. Whoever pressures you under this framing to consent quickly is not acting in accordance with international scientific understanding. See WPATH Files.
"Desistance no longer exists" is sometimes claimed. Classic desistance studies (Steensma 2013) showed that 73–88% of children with dysphoria lost it during adolescence. The Olson 2022 figures concern an already socially transitioned subgroup — not a general figure. See desistance research.
Social transition is not "neutral". The Cass Review documents that social transition increases persistence and therefore the chance of medical treatment.